Healthcare Provider Details

I. General information

NPI: 1861666984
Provider Name (Legal Business Name): JILL M NEWBAUER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST SUITE 225
EDINA MN
55439-2516
US

IV. Provider business mailing address

8100 W 78TH ST SUITE 225
EDINA MN
55439-2516
US

V. Phone/Fax

Practice location:
  • Phone: 952-946-9777
  • Fax: 952-946-9888
Mailing address:
  • Phone: 952-946-9777
  • Fax: 952-946-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberR1659625
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: